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Blepharoplasty - Eyelid Lift
By Michael Russell

In this condition, the orbital fat that cushions the globe of the eye weakens the orbital muscle and a pseudohernia develops. The resulting puffiness of the lower eyelids become conspicuously wrinkled. In older women, the wrinkling may occur without the puffiness. In some cases, the overhang of the upper lid interferes with peripheral vision.

The surgery can be and usually is performed under local anesthesia, but because most patients are nervous about surgery close to the eye, supplemental intravenous or inhalation anesthesia may be advisable. The additional anesthesia relaxes the patient who may suffer some pain when the fat is being removed. Vision is checked before the operation. Some surgeons insert plastic lenses for the protection of the eye and others do not. The surgeons also makes an estimate of the amount of tissue to be removed and usually draws an outline on the eyelid with a colored solution.

The incision on the upper eyelid is ordinarily made in the fold of the lid. The scar is thus concealed when the patient's eye is open. The incision on the lower lid is usually made just beneath the lashes, where it will be hidden. Some surgeons prefer a conjunctival (inside the lid) incision for the lower lid, which eliminates an external scar.

The excess skin is removed and the muscles separated so that fat is exposed and can be gently extracted. Following suturing of the skin, ice compresses may be applied in order to give comfort and limit swelling and discoloration. The sutures are removed in several days. By the tenth day after surgery, the patient generally is presentable without dark glasses. The use of subcuticular (under the skin) sutures eliminates suture marks.

In most instances, the eyelid tissue heals with practically no visible evidence of surgery, although the patient should not anticipate the removal of all wrinkles. In some cases, excessive swelling may turn the lower eyelid out. This postoperative condition almost always disappears with time, but if too much skin has been removed or if there is abnormal scar formation, the drooping eyelid may be permanent and must be corrected with a skin graft.

Another possible postoperative condition is interference with the drainage of tears through the tear ducts, but it is usually temporary. A few cases of loss of vision in one or both eyes have been recorded. The patient must be informed of this possibility. Should symptoms arise, she should immediately be treated.

Some surgeons today like to anchor the under surface of the upper eyelid skin to fascia or cartilage (anchor blepharoplasty). They feel that it gives a better definition to the upper eyelid fold.

There are some women whose eyebrows have sagged so low that it is better to remove skin from above the brows rather than from the upper eyelids. The brows may be elevated from various locations: in the scalp ( the coronal lift), just below the hairline on the forehead (the forehead lift), in a wrinkle line across the forehead, or above the eyebrows.

Michael Russell

Your Independent guide to Cosmetic Surgery

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